By Tom Kiskin Originally Appeared in The Ventura County Star

Prescription costs for people on Medicare, government-paid nursing home stays, in-home care and the cost of flu shots could be affected by proposals to repeal and replace the Affordable Care Act, advocates and other experts said at a senior forum Friday.

“I think they have a huge amount to lose,” advocate Gary Passmore said of seniors.

Passmore, a vice president for the Congress of California Seniors, Assemblywoman Monique Limon, U.S. Rep. Julia Brownley and others talked about the Affordable Care Act and other issues at a senior health and safety focus event in Camarillo. Speakers cautioned that the exact effect of a proposed repeal remains unclear because replacement legislation has not been presented.

Instead, they outlined areas of senior care currently addressed by the Affordable Care Act and possibly posed to be part of the debate in building a replacement program.

The so-called “donut hole” is the gap in coverage for Medicare prescription drugs that was narrowed through President Barack Obama’s signature health program. It’s unclear how a replacement plan would address Medicare prescriptions, but if the bridge across the hole isn’t addressed, it could go away, Passmore said.

He worried, too, about federal funding for in-home care provided through a program called Community First Choice. That funding could be affected by a repeal, Passmore said.

Limon, D-Santa Barbara, worried about her 88-year-old grandmother who has Alzheimer’s disease. Limon is one of her caregivers.

“I know what it’s like to have someone knocking on the door and say your grandmother is wandering on the street,” she said, worrying that dramatic changes to the health care system would translate into less care.

It’s a fear voiced by many at the forum hosted by the Congress of California Seniors.

Harry Nelson is a Los Angeles lawyer who wrote a book on health care in the election’s wake, finishing it in three weeks. It’s called, “From Obamacare to Trumpcare: Why You Should Care.”

After moderating a panel discussion on senior health, Nelson predicted that changes to the health care system ultimately could include caps on Medicare spending. That could mean less federal money for care and more efforts on ways to provide care aimed at keeping people out of emergency rooms and hospitals, he said.

Others focused on an aging society in which 250,000 Americans turn 65 each month.

“I worry about the silver tsunami. I worry about access,” said Dr. Carlo Reyes, an emergency room doctor at Los Robles Hospital & Medical Center in Thousand Oaks. He suggested that dramatic changes to the health care system could send far more people into emergency rooms instead of doctors’ offices.

The Affordable Care Act was designed to cover preventive care ranging from flu shots to colonoscopies. The fate of that free care would depend on a replacement plan, speakers said.

Also unknown is the impact on seniors who qualify not only for Medicare but, because of their income, also state and federally funded Medi-Cal. That coverage includes nursing home care for people who meet Medi-Cal guidelines.

If Medi-Cal and similar programs in other states are funded through block grants as speculated, it could bring a fixed amount of money. State governments could be given the flexibility to eliminate certain benefits or change eligibilty, said Ruth Watson, chief operating officer of Gold Coast Health Plan, which administers Medi-Cal in Ventura County.

“At end of life, there may be an impact,” she said.

Before delivering a keynote speech Friday, Brownley, D-Westlake Village, suggested that people may have to spend more of their own money on health care.

That could pose a problem for seniors.

“People are saving less for their retirement than they ever have before,” she said.